Annals of Surgical Oncology

, Volume 21, Issue 13, pp 4336–4341 | Cite as

Chen’s U-Suture Technique for End-to-End Invaginated Pancreaticojejunostomy Following Pancreaticoduodenectomy

  • Xiao-ping Chen
  • Zhi-yong Huang
  • Josef W. Y. Lau
  • Bi-xiang Zhang
  • Zhi-wei Zhang
  • Yi-fa Chen
  • Wan-guang Zhang
  • Peng Zhu
  • Binhao Zhang
Pancreatic Tumors

Abstract

Background and Purpose

Internationally, postoperative pancreatic fistula (POPF) remains a leading cause of morbidity and mortality after pancreaticoduodenectomy (PD). In order to reduce the incidence of POPF, a number of technical modifications for pancreato-enteric anastomosis after PD have been proposed. In 1995, we established a new technique with transpancreatic transverse U-sutures for end-to-end invaginated pancreaticojejunostomy after a PD, and the preliminary results were quite encouraging. This study aims to review a new surgical approach, the Chen’s U-stitch technique, for end-to-end invaginated pancreaticojejunostomy, which involves two to four transpancreatic transverse U-sutures, and to evaluate the effectiveness of this approach with reducing the incidence of POPF formation.

Methods

To evaluate this new approach, during 2002–2012, a total of 264 patients who received the new Chen’s U-stitch technique after a PD were included in this study. Postoperative morbidity and mortality, including the incidence of POPF, were analyzed.

Results

Postoperative morbidity was 22.3 % (59/264) and mortality was 0 % (0/264). The POPF rate was 3.4 % (9/264) for Grade A, 0.8 % (2/264) for Grade B, and 0 % (0/264) for Grade C.

Conclusions

This new surgical technique (Chen’s U-stitch), which involves an end-to-end invaginated pancreaticojejunostomy with two to four transpancreatic transverse U-sutures, provides excellent outcomes at reducing the incidence of POPF after PD.

Keywords

Pancreatic Duct Pancreatic Fistula Jejunum Loop Pancreatic Stump Postoperative Pancreatic Fistula 

Notes

Acknowledgment

This work was supported by the State key project on inflectional disease of China (Grant numbers 2012ZX10002016-004 and 2012ZX10002010-001-004), the Chinese Ministry of Public Health for Key Clinical Projects (no. 439, 2010) to Professor Xiao-ping Chen.

Conflict of interest

The authors declare no conflict of interest.

Supplementary material

Supplementary material 1 (MPG 44582 kb)

Video 1

Single-needle U-suture technique (cartoon) (WMV 15988 kb)

Video 2

Two-needle U-suture technique (cartoon) (AVI 11483 kb)

Video 3

Two-needle U-suture technique (operative demonstration) (WMV 189946 kb)

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Xiao-ping Chen
    • 1
  • Zhi-yong Huang
    • 1
  • Josef W. Y. Lau
    • 1
  • Bi-xiang Zhang
    • 1
  • Zhi-wei Zhang
    • 1
  • Yi-fa Chen
    • 1
  • Wan-guang Zhang
    • 1
  • Peng Zhu
    • 1
  • Binhao Zhang
    • 1
  1. 1.Department of Surgery, Institute of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina

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